Malignant soft tissue lesions Flashcards
Most important factor for limiting recurrence
margins
Soft tissue sarcomas that spread to regional lymph nodes
rhabdomyosarcoma, synovial sarcoma, clear cell sarcoma, epitheloid sarcoma, angiosarcoma
Most common sarcoma in lower extremities, young adult, cystic appearing with fluid levels, may have mineralization
Synovial sarcoma, mets to lung, Surgical excision and radiation
Translocation for synovial sarcoma
X:18, SYT SSX1 or 2 fusion protein
vimentin, keratin, EMA
Aggressive soft tissue lesion, often in retroperitoneum but moth eaten apearance to metaphysis of long bone, histo blunt cigar shaped nuclei with pink cytoplast
Leiomyosarcoma
wide excision and radiation chemo if lung mets
desmin/actin (muscle), +vimentin (sarcoma)
old person, chronic venous statis, overlying skin changes
angiosarcoma, tumor from endothelium of blood vessels
surgery and radiation
young adult with tumor in hand or forearm, nodular pattern with central necrosis, eosinophilic cytoplasm
epitheliod sarcoma, keratin +, wide resection and radiation
beware of lymph node spread
20-40 yo, usually associated with tendons on dorsum of foot, sheets of cells with clear cytoplasma and spindle cells
clear cell sarcoma, amputation and chemo
clear cell sarcoma translocation and staining
S-100, HMB-45
t(12;22) EWS AFT1, neuroectodermal
most common soft tissue sarcoma in children
rhabdomyosarcoma
Translocation for rhabdomyosarcoma
t(2:13) Pax3-FKHR
Treatment for rhabdomyosarcoma
chemo, resection, radiation
Lymph node spread common, must do bone marrow aspiration
Stains positive in rhabdomyosarcoma
vitemin, desmin/actin, myosin(MyoD1)
most common soft tissue sarcoma, middle aged, deep lesions in thigh or retroperitoneum
Liposarcoma
chromosomal translocation of myxoid liposarcoma
t(12;16) CHOP,TLS
MDM2
always order CT chest/ab/pelvis in myxoid
Types of liposarcoma
well-differentieated, myxoid, round cell, pleomorphic, undiff
treatment for liposarcoma
resection and radiation
Important prognostic factor in melanoma
depth
Treatment of melanoma
<1mm local resection
> 1mm local resection with 1-2cm margin, sentinel node bx
Tumor of brown fat
hibernoma
Treatment of atypical liposarcoma
resection
Patient with history of abdominal wall cancer, possible historyof FAP or Gardner syndrome, aggressive bubbly lesion if in bone
Desmoid tumor (fibromatosis), desmoplastic fibroma
usually around shoulder
dense spindlecellsin rows with elongated nuclei
Treatment of desmoid tumor
NSAID, chemo, resection
tamoxifen if estrogen receptor positive
increased beta catenin (trisomy 8 or 20)
Recurrent atraumatic hemoarthrosis, possible erosive changes on xrays, blooms on MRI
PVNS (tenosynovial giant cell)
hemosiderin in giant cells
focal nodular (simpe excision), extensive synovectomy plus radiation otherwise
Over expression of CSF-1 (pexidantinib)
Middle aged patient with painful mass on finger tip, bluish color, nail ridging, sensitive
Glomus tumor (pain, tenderness, cold intolerance) - perivascular temp regulating structure
small round blue cells on histo
Marginal excision
Middle aged patient with metaplastic changes in synovial tissue and chondroid loose bodies in the joint
Synovial chondromatosis (osteochondromatosis if mineralized on xray)
marbles in joint, histo shows hyaline cartilage
remove loose bodes and synovectomy
